- Liu et al (Circulation April 15, 2020;doi:10.1161/CIRCULATIONAHA.120.047549, PMID 32293910) provided an overview of coronavirus disease 2019 (COVID-19) that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The high infectivity of the SARS-CoV-2 virus is contributed by new mutations in the receptor-binding domain and acquisition of a furin cleavage site in the S spike protein. The virus uses the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry, which is mediated by the host cell serine protease TMPRSS2.
- Coronavirus disease 2019 (COVID-19) is highly infectious and causes significant strains on health care systems. Routine testing within the hospital is weighed for needed value to minimize exposure to staff. The combination of hydroxychloroquine and azithromycin, both known to prolong the QT interval, was shown to lower the viral load, and early in the COVID-19 pandemic, the drugs were used to try to lower the morbidity and mortality of the infection. Gabriels et al (doi: https://doi.org/10.1016/j.hrcr.2020.03.017 ) shared a case of a 72-year-old woman with paroxysmal atrial fibrillation, treated with flecainide and metoprolol, who presented with dyspnea, cough, fevers, and chills.
- Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been shown to be associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. The current study by Hoffmann et al (Cell 2020;doi:10.1016/j.cell.2020.02.052; PMID 32142651) investigates the mechanisms of SARS-CoV-2 entry into mammalian cells. The spike (S) protein of coronaviruses facilitates viral entry into target cells by binding of the surface unit (S1) of the S protein to a cellular receptor, angiotensin-converting enzyme 2 (ACE2), as the entry receptor.
- In a departure from the usual format of review of 1 article followed by a discussion of 1 topic, given the unusual times, the discussion of 1 topic will predominate. There are already hundreds of articles with topics such as the cardiovascular manifestations of coronavirus disease (COVID-19), the increased risk to patients with preexisting cardiovascular disease, arrhythmias associated with infection, and proarrhythmic effects of proposed treatments to be found with a simple Google or PubMed search.
- Lakkireddy et al (Heart Rhythm April 1, 2020; https://doi.org/10.1016/j.hrthm.2020.03.028 , PMID 32228309) summarized the available evidence and provided recommendations for electrophysiologists related to coronavirus 2019 (COVID-19) in a consensus document from the Heart Rhythm Society, American College of Cardiology, and American Heart Association. They noted that electrophysiologists, like all cardiologists and other health care workers, have been affected personally and professionally by this global catastrophe.
- The phenotype of Brugada syndrome is associated with a decrease in the sodium current and can manifest with sudden death in previously healthy individuals. Many triggers have been described, including fever, alcohol intake, and medications that cause sodium channel blockade. Coronavirus disease 2019 (COVID-19) most commonly presents with fever and a cough. Chang et al (doi: https://doi.org/10.1016/j.hrcr.2020.03.012 ) shared a case of a 49-year-old Bangladeshi man without a significant medical history who presented after an episode of syncope and fever.